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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Maugana VF, Kruger R, Kruger HS, Hanssen H, Smith W. Food intake in South African children and retinal microvascular health: The ExAMIN Youth SA study. Nutr Metab Cardiovasc Dis 2024; 34:188-197. [PMID: 37798229 DOI: 10.1016/j.numecd.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Retinal arteriolar narrowing and venular widening are associated with increased cardiovascular risk, even at young ages. Whether diet contributes to early microvascular changes in children is not widely explored. We explored the associations of frequency of healthy and unhealthy food group intake with retinal vessel calibers in black and white children. METHODS AND RESULTS This study included school-aged (5-9 years) black (N = 433, 7.46 ± 0.98 years), and white (N = 403, 7.43 ± 0.82 years) children. Anthropometric and blood pressure measurements were taken, along with retinal vessel calibers (central retinal arteriolar (CRAE) and venular (CRVE) equivalents). Frequencies of food group intake were assessed using a food-frequency questionnaire. A factor analysis was performed to describe food group patters. Independent associations between retinal vessel calibers and frequencies of food group intake and food group patters were explored. In black children, cookies, cakes, and biscuits were associated with narrower arterioles (p < 0.05). In white children, cold sweetened beverages were associated with narrower arterioles (p = 0.02), whereas salty snacks were associated with narrower arterioles (p = 0.01) and wider venules (p < 0.05). Fruits were positively associated with CRAE (p = 0.03) in white children only. CONCLUSION A higher frequency of unhealthy food group consumption was associated with retinal arteriolar narrowing and venular widening in both black and white children. However, fruit intake was shown beneficial for retinal microvascular health in white children only. Our findings may highlight the importance of promoting healthy eating patterns from early childhood which may reduce the risk of premature cardiovascular disease development.
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Affiliation(s)
- Vuledzani F Maugana
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Henner Hanssen
- Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; SAMRC Extramural Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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Wuopio J, Lin YT, Orho-Melander M, Engström G, Ärnlöv J. The association between sodium intake and coronary and carotid atherosclerosis in the general Swedish population. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead024. [PMID: 37006408 PMCID: PMC10063371 DOI: 10.1093/ehjopen/oead024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/11/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
Aims A high intake of salt raises blood pressure and the risk of cardiovascular disease. Previous studies have reported on the association between salt intake and carotid stenosis, but the association with coronary atherosclerosis has not been reported. Therefore, this project aimed at studying the association between salt intake and both carotid and coronary atherosclerosis in a contemporary community-based cohort. Methods and results Estimated 24-h sodium excretion (est24hNa) was calculated by the Kawasaki formula for participants of two sites (Uppsala and Malmö) of the Swedish Cardiopulmonary bioImage Study, who underwent a coronary computed tomography (n = 9623) and measurement of coronary artery calcium score (CACS, n = 10 289). Carotid ultrasound was used to detect carotid plaques (n = 10 700). Ordered logistic regression was used to calculate odds ratios (OR) per 1000 mg increase in est24hNa. We also investigated potential J-formed associations using quintiles of est24hNa. Increased est24hNa was associated with increased occurrence of carotid plaques [OR: 1.09, P < 0.001, confidence interval (CI): 1.06-1.12], higher CACS (OR: 1.16, P < 0.001, CI: 1.12-1.19), and coronary artery stenosis (OR: 1.17, P < 0.001, CI: 1.13-1.20) in minimal adjusted models. Associations were abolished when adjusting for blood pressure. When adjusting for established cardiovascular risk factors (not including blood pressure), associations remained for carotid plaques but not for coronary atherosclerosis. There was no evidence of J-formed associations. Conclusion Higher est24hNa was associated with both coronary and carotid atherosclerosis in minimal adjusted models. The association seemed mainly mediated by blood pressure but to some degree also influenced by other established cardiovascular risk factors.
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Affiliation(s)
- Jonas Wuopio
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobels Allé 23, 141 52, Huddinge, Sweden
- Center for Clinical Research Dalarna, Nissers väg 3, 791 82 Falun, Uppsala University, Sweden
| | - Yi-Ting Lin
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobels Allé 23, 141 52, Huddinge, Sweden
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzou 1 Road Kaohsiung, Sanmin District, Kaoshiung City, 807, Taiwan
| | - Marju Orho-Melander
- Department of Clinical Sciences, Lund University, Clinical Research Centre, Box 50332, 202 13 Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Clinical Research Centre, Box 50332, 202 13 Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobels Allé 23, 141 52, Huddinge, Sweden
- Center for Clinical Research Dalarna, Nissers väg 3, 791 82 Falun, Uppsala University, Sweden
- School of Health and Social Studies, Dalarna University, 79188 Falun, Sweden
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Ledeganck KJ, Van Eyck A, Wouters K, Vermeiren E, De Winter BY, Verhulst S, Van Hoorenbeeck K, France A, Dotremont H, den Brinker M, Trouet D. Urinary epidermal growth factor reflects vascular health in boys with either obesity or type 1 diabetes. A role for renin, or beyond? PLoS One 2023; 18:e0283716. [PMID: 36996194 PMCID: PMC10062545 DOI: 10.1371/journal.pone.0283716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
An increased blood pressure is a known comorbidity of both type 1 diabetes (T1DM) and obesity in children. Increasing evidence suggests a subtle interplay between epidermal growth factor (EGF) and renin along the juxtaglomerular system, regulating the impact of blood pressure on kidney health and the cardiovascular system. In this study, we investigated the relation between urinary EGF, serum renin and blood pressure in children with obesity or T1DM. 147 non-obese children with T1DM and 126 children with obesity, were included. Blood pressure was measured and mean arterial pressure (MAP) and the pulse pressure (PP) were calculated. Serum renin and urinary EGF levels were determined with a commercial ELISA kit. Partial Spearman rank correlation coefficients and multiple linear regression models were used to study the association between renin, the urinary EGF/urinary creatinine ratio and blood pressure parameters. The urinary EGF/urinary creatinine ratio is correlated with the SBP and the MAP in boys with obesity as well as in boys with T1DM. Multiple regression analysis showed that sex and pulse pressure in male subjects were found to be independently associated with renin. Sex, the presence of diabetes, age, the glomerular filtration rate and both pulse pressure and mean arterial pressure in male subjects were independently associated with urinary EGF/urinary creatinine. In conclusion, in boys with either obesity or diabetes, pulse pressure and mean arterial pressure are negatively associated with the functional integrity of the nephron, which is reflected by a decreased expression of urinary EGF.
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Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annick France
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Hilde Dotremont
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Marieke den Brinker
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium
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Estimating the changing disease burden attributable to raised low-density lipoprotein cholesterol in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:607-616. [DOI: 10.7196/samj.2022.v112i8b.16489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background. Low-density lipoprotein cholesterol (LDL-C) is the most important contributor to atherosclerosis, a causal factor for ischaemic heart disease (IHD) and ischaemic stroke. Although raised LDL-C is a key contributor to cardiovascular disease (CVD), the exact attributable disease risk in South Africa (SA) is unknown. The the first SA comparative risk assessment (SACRA1) study assessed the attributable burden of raised total cholesterol, and not specifically LDL-C.
Objectives. To estimate the national mean serum LDL-C by age, year and sex and to quantify the burden of disease attributable to LDL-C in SA for 2000, 2006 and 2012.
Methods. The comparative risk assessment (CRA) method was used. Estimates of the national mean of LDL-C, representing the 3 different years, were derived from 14 small observational studies using a meta-regression model. A theoretical minimum risk exposure level (TMREL) of 0.7 - 1.3 mmol/L was used. LDL-C estimates together with the relative risks from the Global Burden of Disease Study 2017 were used to calculate a potential impact fraction (PIF). This was applied to IHD and ischaemic stroke estimates sourced from the Second National Burden of Disease Study. Attributable deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were calculated. Uncertainty analysis was performed using Monte Carlo simulation.
Results. LDL-C declined from 2.74 mmol/L in 2000 to 2.58 mmol/L in 2012 for males, while in females it declined from 3.05 mmol/L in 2000 to 2.91 mmol/L in 2012. The PIFs for LDL-C showed a slight decline over time, owing to the slight decrease in LDL-C levels. Attributable DALYs increased between 2000 (n=286 712) and 2006 (n=315 125), but decreased thereafter in 2012 (n=270 829). Attributable age-standardised death rates declined between 2000 and 2012 in both sexes: in males from 98 per 100 000 members of the population in 2000 to 78 per 100 000 in 2012, and in females from 81 per 100 000 in 2000 to 58 per 100 000 in 2012.
Conclusions. Mean LDL-C levels were close to 3 mmol/L, which is the recommended level at which cholesterol-lowering treatment should be initiated for people at low and moderate risk for cardiovascular outcomes. The decreasing trend in the age-standardised attributable burden due to LDL-C is encouraging, but it can be lowered further with the introduction of additional population-based CVD prevention strategies. This study highlights the fact that high LDL-C concentration in relation to the TMREL in SA is responsible for a large proportion of the emerging CVD, and should be targeted by health planners to reduce disease burden.
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Sallehuddin SM, Ambak R, Othman F, Aziz NSA, Palaniveloo L, Nor NSM, Jamaluddin R, Baharudin A, Zaki NAM, Ahmad MH. Sodium intake assessed by 24-h urine excretion and its relationship with anthropometric measurements in Malaysian adults. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:9. [PMID: 34059153 PMCID: PMC8165987 DOI: 10.1186/s41043-021-00234-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sodium intake is associated with anthropometric measurement including weight, waist circumference (WC), and body mass index (BMI). Higher intake of sodium is usually linked to higher risk of obesity among adults globally, especially in developing countries. This study aims to explore the probable relationship between sodium intake by 24-h urine excretion assessment and anthropometric measurement of adults in Malaysia. METHODS A cross-sectional study was conducted from October 2017 to March 2018 using a multi-stage stratified sampling method among Malaysian adults aged 18 years old and above. Sodium intake was determined by 24-h urinary sodium excretion, estimated from the respondents' 24-h urinary sample. Height was obtained based on standard protocol. Weight and WC were measured twice using validated anthropometric equipment and BMI was calculated according to World Health Organization (WHO) 1998 classification. Descriptive analysis was done to describe socio-demographic characteristics. A simple linear regression and multiple linear regression tests were done to assess the relationship of 24-h urinary excretion and anthropometric measurement. All statistical analysis was done using SPSS version 22.0. RESULTS Of 1047 interviewed respondents, 798 respondents had done the 24-h urine collection (76.0% response rate). Majority was between 40 and 59 years old (43.5%) and married (77.7%). Simple linear regression showed a significant positive linear association between 24-h urinary excretion and household income, WC, and obese group. In the multivariate analysis, it was indicated that, an increase of 1 unit of BMI will significantly increase the sodium intake by 129.20 mg/dl and an increase of 1 cm of WC will significantly increase the sodium intake by 376.45 mg/dl. CONCLUSION Our study showed a positive significant relationship between sodium intake estimated by 24-h urinary sodium excretion and BMI of Malaysian adults. More research is suggested on how sodium control can potentially contribute to obesity prevention.
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Affiliation(s)
- Syafinaz Mohd Sallehuddin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nur Shahida Abd Aziz
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Lalitha Palaniveloo
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Noor Safiza Mohd Nor
- Policy and Strategic Planning Section, Allied Health Science Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Rasidah Jamaluddin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Azli Baharudin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak Malaysia
| | - Nor Azian Mohd Zaki
- Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak Malaysia
| | - Mohamad Hasnan Ahmad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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The association between dietary sodium intake, adiposity and sugar-sweetened beverages in children and adults: a systematic review and meta-analysis. Br J Nutr 2020; 126:409-427. [PMID: 33054868 DOI: 10.1017/s0007114520004122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Higher intakes of Na may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary Na intake and measures of adiposity in children and adults. Given the previous link between Na intake and the consumption of sugar-sweetened beverages (SSB), which are a known risk factor for obesity, a secondary aim examining the relationship between Na intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCT) which reduced dietary Na (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher Na intakes were associated with overweight/obesity in adults (five studies; n 11 067; OR 1·74; 95 % CI 1·43, 2·13) and in children (three studies; n 3625, OR 3·29; 95 % CI 2·25, 4·80), and abdominal obesity (five studies; n 19 744; OR 2·04; 95 % CI 1·72, 2·42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCT in adults indicated a trend for lower body weight on reduced-Na compared with control diets (fifteen studies; n 5274; -0·29 kg; 95 % CI -0·59, 0·01; P = 0·06); however, it is unclear if energy intakes were also altered on reduced-Na diets. Among children higher Na intakes were associated with higher intake of SSB (four studies, n 10 329, b = 22, 16 and 26 g/d); no studies were retrieved for adults. Overall, there was a lack of high-quality studies retrieved. While cross-sectional evidence indicates Na intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or RCT.
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Overwyk KJ, Quader ZS, Maalouf J, Bates M, Webster J, George MG, Merritt RK, Cogswell ME. Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019. Adv Nutr 2020; 11:1174-1200. [PMID: 32449929 PMCID: PMC7490163 DOI: 10.1093/advances/nmaa049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.
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Affiliation(s)
- Katherine J Overwyk
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Zerleen S Quader
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Joyce Maalouf
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Marlana Bates
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
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Sabir JSM, Omri AE, Ali Khan I, Banaganapalli B, Hajrah NH, Zrelli H, Omar AMS, Alharbi MG, Alhebshi AM, Jansen RK, Altaf A, Shaik NA, Khan M. ACE insertion/deletion genetic polymorphism, serum ACE levels and high dietary salt intake influence the risk of obesity development among the Saudi adult population. J Renin Angiotensin Aldosterone Syst 2019. [PMCID: PMC6732865 DOI: 10.1177/1470320319870945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Angiotensin-converting enzyme (ACE), which contributes to
adipocyte growth, differentiation and function, has recently been linked
with both salt metabolism and obesity development. Therefore, this study has
aimed to investigate the putative relationship between ACE
genetic polymorphism, serum ACE levels and salt consumption
on the risk of developing obesity in the Saudi population. Materials and methods: ACE genotype status of 267 adult Saudi volunteers (124 obese
and 143 non-obese) was correlated with their serum ACE
activity and dietary salt intake amounts. Results: Obesity was more prevalent in deletion-deletion genotype individuals
(p<0.03), under dominant, co-dominant and
monoallelic conditions (p<0.04). Deletion allele
corresponds to serum ACE activity in obese patients
(p<0.05). The amount of salt intake (<6 g/d) was
significantly associated with obesity and particularly high in
deletion-deletion and insertion-deletion genotype carriers
(p<0.001). STITCH analysis underlined interactions
of the ACE protein with sodium molecule,
REN, ACE2, KNG1 and
AGTR1 in a biological network. Conclusions: Our findings suggest the positive association between ACE
deletion genotype, serum ACE activity and sodium intake
with risk of obesity development in the Saudi population.
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Affiliation(s)
- Jamal SM Sabir
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Abdelfatteh El Omri
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Imran Ali Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Babajan Banaganapalli
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Nahid H Hajrah
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Houda Zrelli
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Abdulkader M Shaikh Omar
- Department of Biology, Zoology Division, Faculty of Sciences, King Abdulaziz University, Saudi Arabia
| | - Mona G Alharbi
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Alawiah M Alhebshi
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
| | - Robert K Jansen
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Department of Integrative Biology, University of Texas at Austin, Austin, USA
| | - Abdulmalik Altaf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Noor Ahmad Shaik
- Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Saudi Arabia
| | - Muhummadh Khan
- Center of Excellence in Bionanoscience Research, King Abdulaziz University, Saudi Arabia
- Genomics and Biotechnology Section and Research Group, Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Saudi Arabia
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10
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Schutte AE, Gona PN, Delles C, Uys AS, Burger A, Mels CM, Kruger R, Smith W, Fourie CM, Botha S, Lammertyn L, van Rooyen JM, Gafane-Matemane LF, Mokwatsi GG, Breet Y, Kruger HS, Zyl TV, Pieters M, Zandberg L, Louw R, Moss SJ, Khumalo IP, Huisman HW. The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination. Eur J Prev Cardiol 2019; 26:458-470. [PMID: 30681377 PMCID: PMC6423686 DOI: 10.1177/2047487318822354] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Globally hypertension is stabilising, but in sub-Saharan Africa the incidence
of hypertension remains on an increase. Although this might be attributed to
poor healthcare and ineffective antihypertensive treatment, there is a
limited understanding of population and individual-specific cardiovascular
pathophysiology – necessary for effective prevention and treatment
strategies in Africa. As there is a lack of longitudinal studies tracking
the early pathophysiological development of hypertension in black
populations, the African-PREDICT study was initiated. The purpose of this
paper is to describe the detailed methodology and baseline cohort profile of
the study. Methods and results From 2013 to 2017, the study included 1202 black (N = 606)
and white (N = 596) men and women (aged 20–30 years) from
South Africa – screened to be healthy and clinic normotensive. At baseline,
and each 5-year follow-up examination, detailed measures of health
behaviours, cardiovascular profile and organ damage are taken. Also,
comprehensive biological sampling for the ‘omics’ and biomarkers is
performed. Overall, the baseline black and white cohort presented with
similar ages, clinic and 24-hour blood pressures, but black adults had lower
socioeconomic status and higher central systolic blood pressure than white
individuals. Conclusions The prospective African-PREDICT study in young black and white adults will
contribute to a clear understanding of early cardiovascular disease
development.
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Affiliation(s)
- Aletta E Schutte
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Philimon N Gona
- 3 Department of Exercise and Health Sciences, University of Massachusetts Boston, USA
| | - Christian Delles
- 4 Institute of Cardiovascular and Medical Sciences (ICAMS), University of Glasgow, UK
| | - Aletta S Uys
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Adele Burger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Catharina Mc Mels
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Ruan Kruger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Wayne Smith
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Carla Mt Fourie
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Shani Botha
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Leandi Lammertyn
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Johannes M van Rooyen
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Lebo F Gafane-Matemane
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Gontse G Mokwatsi
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Yolandi Breet
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - H Salome Kruger
- 2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.,5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Tertia van Zyl
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Marlien Pieters
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Lizelle Zandberg
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Roan Louw
- 6 Human Metabolomics, North-West University, South Africa
| | - Sarah J Moss
- 7 Physical activity, Sport and Recreation Research Focus Area, North-West University, South Africa
| | | | - Hugo W Huisman
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
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